Abstract
Purpose
In periprosthetic femoral fractures, our hypothesis was that when the bone and implant are stable, the fracture does not occur at the biologic or cement fixation regions but occurs at the no fixation region. The aim of this study was to investigate the validity of our new classification for periprosthetic femoral fractures and compare reliability of radiographic evaluation for implant stability between our classification and the Vancouver classification.
Patients and methods
Sixty-six patients with periprosthetic femoral fracture were operatively treated by us between 2005 and 2013. We investigated the sensitivity and specificity of our new classification with actual implant stability. Twenty patients were randomly selected from 66 patients. After fully explaining the Vancouver and our new classification to four orthopaedic surgeons, plain radiographs acquired in two directions at the time of injury were presented, and the interobserver reliability based on the two classifications and accuracy rates of stem stability were investigated.
Results
The specificity of the new classification was 89 %, and sensitivity was 94 %. The positive and negative predictive values were 84 % and 96 %, respectively. Interobserver agreement was separately assessed among all possible pairs of orthopaedic surgeons. The κ values for the Vancouver and the new classification were 0.36 (0.19–0.49) and 0.76 (0.66–1.0), respectively.
Conclusions
Our classification is based on a completely new concept and was prepared to overcome periprosthetic femoral fracture failures by objective evaluation. We believe this new classification is useful to establish a therapeutic strategy for femoral fractures around the stem.
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References
Learmonth ID (2004) Aspects of current management. The management of periprosthetic fractures around the femoral stem. J Bone Joint Surg (Br) 86:13–19
Masri BA, Meek D, Duncan CP (2004) Periprosthetic fractures evaluation and treatment. Clin Orthop 420:80–95
Kavanagh BF (1992) Femoral fracture associated with total hip arthroplasty. Orthop Clin North Am 23:249–257
Davidson D, Pike J, Garbuz D, Duncan CP, Masri BA (2008) Intraoperative periprosthtic fractures during total hip arthroplasty. J Bone Joint Surg Am 90:2000–2012
Baba T, Shitoto K, Kaneko K, Futamura K, Maruyama Y (2013) Comparison of therapeutic outcomes of periprosthetic femoral fracture between treatments employing locking and conventional plates. Eur J Orthop Surg Traumatol 23:437–441
Ahuja S, Chatterji S (2002) The Mennen femoral plate for fixation of periprosthetic femoral fractures following hip arthroplasty. Injury 33:47–50
Montijo H, Ebert FR, Lennox DA (1989) Treatment of proximal femur fractures associated with total hip arthroplasty. J Arthroplasty 4:115–123
Tsiridis E, Haddad FS, Gie GA (2003) Dall-Miles plates for periprosthtic femoral fractures A critical review of 16 cases. Injury 34:107–110
Duncan CP, Masri BA (1995) Fracture of the femur after hip replacement. Instr Course Lect 44:293–304
Canbora K, Kose O, Polat A, Aykanat F, Gorgec M (2013) Management of Vancouver type B2 and B3 femoral periprosthetic fractures using an uncemented extensively porous-coated long femoral stem prosthesis. Eur J Orthop Surg Traumatol 23:545–552
Moloney GB, Westrick ER, Siska PA, Tarkin IS (2014) Treatment of periprosthetic femur fractures around a well-fixed hip arthroplasty implant: span the whole bone. Arch Orthop Trauma Surg 134:9–14
Neumann D, Thaler C, Dorn U (2012) Management of Vancouver B2 and B3 femoral periprosthetic fractures using a modular cementless stem without allografting. Int Orthop 36:1045–1050
Landis JR, Koch GC (1977) The measurement of observer agreement for categorical data. Biometics 33:159–174
Johansson JE, McBroom R, Barrington TW, Hunter GA (1981) Fracture of the ipsilateral femur in patients with total hip replacement. J Bone Joint Surg Am 63:1435–1442
Corten K, Vanrykel F, Bellemans J, Frederix PR, Simon JP, Broos PL (2009) An algorithm for the surgical treatment of periprosthetic fractures of the femur around a well-fixed femoral component. J Bone Joint Surg (Br) 91:1424–1430
Rayan F, Dodd M, Haddad FS (2008) European validation of the Vancouver classification of periprosthetic proximal femoral fractures. J Bone Joint Surg (Br) 90:1576–1579
Naqvi GA, Baig SA, Awan N (2012) Interobserver and intraobserver reliability and validity of the Vancouver classification system of periprosthetic femoral fractures after hip arthroplasty. J Arthroplasty 27:1047–1050
Laurer HL, Wutzler S, Possner S, Geiger EV, El Saman A, Marzi I, Frank J (2011) Outcome after operative treatment of Vancouver type B1 and C periprosthetic femoral fractures: open reduction and internal fixation versus revision arthroplasty. Arch Orthop Trauma Surg 131:983–989
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Baba, T., Homma, Y., Momomura, R. et al. New classification focusing on implant designs useful for setting therapeutic strategy for periprosthetic femoral fractures. International Orthopaedics (SICOT) 39, 1–5 (2015). https://doi.org/10.1007/s00264-014-2476-x
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DOI: https://doi.org/10.1007/s00264-014-2476-x